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Impacts of a disability or long-term condition on training and clinical working

Overview

Postgraduate medical and dental training is demanding for any clinician, and PGDiTs with disabilities and long-term conditions may face additional challenges that their non-disabled peers do not. With the right support, adjustments, and planning, however, many of these challenges are manageable, and many doctors and dentists with disabilities go on to have full and successful careers.

This page is intended to help you understand the kinds of impacts a disability or long-term condition may have on your training and clinical work, the kinds of support and adjustments that can be put in place, and how to access them.

Contents

Common impacts

Every individual's experience is different, and the impact of a condition will depend on its nature, severity, fluctuation, and the specific demands of the specialty you are training in. Below are some examples of common impacts.

 

Energy and stamina

Many long-term conditions such as chronic fatigue, autoimmune, cardiovascular and respiratory conditions can significantly affect energy levels. This can be particularly challenging when combined with long shift and on-call commitments and the general cognitive demands of working in a busy clinical environment.

 

Pain and physical Functioning

Chronic pain, musculoskeletal conditions and physical disabilities may affect a PGDiT’s ability to stand for long periods, perform physical examinations or carry out procedures.

 

Sensory impairments

Hearing or visual impairments may require specific equipment, adjustments to communication methods, or adaptations to clinical tasks.

Cognitive effects

Certain conditions can affect cognition, concentration or memory, such as neurological and mental health conditions. Medical can also cause an impact. This may affect aspects of learning, sitting examinations, or performing clinical and administrative tasks.

Fluctuating symptoms

Health conditions often fluctuate, sometimes on a day-to-day basis, and this can be unpredictable. This unpredictability can make the arrangement of and access to adjustments and planning of clinical workloads challenging, as well as complicate the decision to disclose to employers and educators.

Treatment burden

Attending appointments, undergoing tests, taking medication and managing practicalities of a long-term condition or disability can be a significant and tiring commitment alongside the demands of training.

Emotional and psychological impact

Living with a long-term condition, especially whilst undertaking demanding work, can take an emotional toll. Many PGDiTs with long-term conditions experience anxiety, low mood or grief related to their health alongside the condition itself. This can be particularly true for those who receive a diagnosis or acquire an impairment during their training.

Reasonable Adjustments

The Equality Act places a legal duty on employers to make reasonable adjustments for employees who meet the legislation’s definition of disability: a physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on your ability to do normal activities.

A "reasonable" adjustment is one that removes or reduces a substantial disadvantage faced by a disabled person, where the adjustment itself is reasonable for the employer to make. Reasonableness takes into account the effectiveness of the adjustment, its cost, the size and resources of the employer, and the practicality of implementing it.

Where a PGDiT meets the legal definition of disability under the Equality Act 2010, their employing trust has a legal duty to consider and implement reasonable adjustments. A request cannot be refused on the basis of inconvenience or precedent alone.

If a request for an adjustment is declined, you have the right to ask for the reasons in writing, and to seek advice from your trade union.

For further information about the Equality Act 2010, Disability Rights UK provides clear guidance on the legislation, reasonable adjustments, and your rights at work.

Examples of adjustments

Reasonable adjustments are highly personalised and both depend upon the condition and individual preference and needs.

Examples of adjustments that may be appropriate include:

  • Modified working hours, including reduced hours, less-than-full-time training, or adjusted shift patterns
  • Modifications to on-call commitments
  • Specialist equipment or assistive technology
  • Adjustments to clinical tasks where appropriate
  • A phased return to work and supernumerary period after an absence
  • Time off for medical appointments and treatment
  • Additional supervision, mentoring, or peer support
  • Adjusted placement allocation where geography or specific working environments are relevant

The right combination of adjustments will be individual, and the most successful arrangements are usually those developed collaboratively between the PGDiT, their educators, and their employer.

Access to Work

Access to Work is a government scheme that can provide financial support for adjustments and equipment that go beyond what an employer would normally be expected to provide. This may include specialist equipment, support workers, travel costs, and mental health support. Access to Work assessments are based on individual need rather than diagnosis, and many PGDiTs find an Access to Work grant valuable in funding adjustments that materially improve their working life.

For more information on Access to Work and how to apply, please see our Reasonable Adjustments and Practical Support pages.

Less than full time (LTFT) training

Some PGDiTs with long-term conditions choose to apply for LTFT training, which allows them to train at a reduced percentage of full-time hours. For information about the LTFT process, including how to apply and relevant deadlines, please see the NHSE YH LTFT Standard Operating Procedure and Guidance.

Adjustments in examinations

Applications for reasonable adjustments in professional examinations are managed by the relevant royal college or examining body. An application for adjustments is often required separately to applying for the examination, though it may have the same deadline for submission.

Please refer to your examining body’s reasonable adjustment policy and process for specific guidance and applicable deadlines. This information can be found on their individual website.

Sources of support

BMA Disability Equity in the Workplace provides guidance for doctors with disabilities and the NHS Practitioner Health's Disability Support guide is applicable to both doctors and dentists.

Disabled Doctors Network is a peer network specifically for doctors with disabilities and long-term conditions.

Please see Support for PGDiTs with a disability or long-term condition and our External Support Services Directory for signposts to other support services. 

 

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